Key result
Combined cardiac procedures with carotid bypass surgery, particularly TEVAR, significantly increased the incidence of post-operative stroke (P < 0.001), most commonly presenting as multiple scattered infarctions.
Why the study?
Few previous studies have provided information on the imaging patterns of stroke after cardiac surgery.
What is the incidence and imaging pattern of stroke after different types of cardiac surgery in adult patients?
Observational (n=3,645)
No
What is the incidence and imaging pattern of stroke after different types of cardiac surgery in adult patients?
p-value: p=< 0.001
Post-cardiac surgery stroke occurs in 1.8% of patients, predominantly as multiple scattered infarctions, with the highest risk observed in procedures involving carotid bypass such as TEVAR.
TEVAR with carotid bypass may elevate post-cardiac surgery stroke risk; leaves open optimal prevention strategies for prospective trials.
Background: Few cases of patients of previous studies have provided information on imaging patterns of stroke after cardiac surgery. Objective: The purpose of this study was to determine the incidence and imaging pattern of stroke after cardiac surgery according to type of cardiac surgery. Methods: A retrospective observational study was conducted on 3,645 adult patients who underwent cardiac surgery in cardiovascular thoracic unit at our institute from January 1, 2010 – September 30, 2019. Cases of patients who were suspected of having post-operative stroke and on whom brain imaging had been performed were reviewed. The ischemic stroke was categorized into four subtypes including large territorial infarction, multiple scattered infarctions, small infarction, and watershed infarction. Results: Stroke after cardiac surgery was suspected in 90 patients. Sixty-seven patients (1.8%) had a diagnosis of ischemic stroke confirmed by imaging. The incidence of stroke in combined cardiac procedure with carotid bypass surgery was significantly high, especially in thoracic endovascular aortic repair (TEVAR) with carotid bypass surgery (P < 0.001). Multiple scattered infarctions (61.2%) was the most common pattern which was predominant in both anterior and posterior circulation. It was found to have no significant association between type of surgery and pattern of stroke (P = 0.70). Overall, stroke related death within 30 days post cardiac surgery was 0.2% (7/3645). Conclusions: Procedures that included carotid bypass surgery increased the incidence of stroke after cardiac surgery significantly, especially TEVAR with carotid bypass surgery. The most common pattern of stroke after cardiac surgery was the multiple scattered pattern.
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Saruda Vichitpunt (2022) conducted an observational in Cardiac surgery (n=3,645). Combined cardiac procedure with carotid bypass surgery (especially TEVAR) vs. Other types of cardiac surgery was evaluated on Incidence of ischemic stroke confirmed by imaging (p=< 0.001). Combined cardiac procedures with carotid bypass surgery, particularly TEVAR, significantly increased the incidence of post-operative stroke (P < 0.001), most commonly presenting as multiple scattered infarctions.
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